Mastectomy scar boosts and dose escalation to the chest wall are not needed to achieve excellent local control in patients with locally advanced and inflammatory breast cancer

[Radiation therapy in inflammatory breast cancer]

BACKGROUND

Inflammatory breast cancer accounts for 1-5% of all breast cancers. It is associated with a poor prognosis, because of an increased risk to develop metastases in comparison with all breast malignancies. The treatment is multimodal. We have evaluated the role of radiotherapy: indications, techniques and impact for local control and overall survival.

METHOD

The series of the literature with more than 40 patients irradiated for inflammatory breast cancer published since 1995 were analyzed.

RESULTS

Chemotherapy was always delivered first. Adjuvant radiotherapy was associated with local control and overall survival at 10 years of 63-92% and 51-64 respectively. Without surgery, local control was 65% and overal survival 38% at 10years. Results of concomitant radiochemotherapy were reported: the studies were heterogenous. Modalities of radiotherapy were detailed with respect to dose and fractionation, target-volumes and technical considerations (including bolus).

CONCLUSION

The multimodal strategy comprises systematically radiotherapy with an evaluation of tumor response to maximise resecability.

Radiation therapy for inflammatory breast cancer: technical considerations and diverse clinical scenarios

SUMMARY Inflammatory breast cancer (IBC) is associated with unique skin findings at presentation, diffuse spread and poorer outcomes compared with non-IBC. Standard of care when metastatic disease is not present at diagnosis includes neoadjuvant chemotherapy, modified radical mastectomy and postmastectomy radiation. Several retrospective studies have demonstrated reasonable local control using varying aggressive approaches that will be reviewed and technical considerations that will be discussed. In general, the existing contemporary data support an aggressive locoregional approach in IBC. The morbidity of extensive locoregional recurrence in IBC merits aggressive efforts in prevention in high-risk metastatic cases. Our large, single-institutional experience suggests that contralateral disease and extension to second echelon nodal stations may still represent curable disease amenable to aggressive locoregional therapy in some cases. Examining 13 IBC cases where contralateral involved nodal basins were treated with radiotherapy with or without surgery at the time of ipsilateral locoregional therapy, four ER-positive patients presented evidence of disease at the last follow-up. Examining 36 patients with metastatic IBC involving any M1 site who underwent neoadjuvant chemotherapy, modified radical mastectomy and postmastectomy radiotherapy similarly revealed that a long-term status of no evidence of disease is achievable in some M1 IBC patients treated with effective systemic therapy and aggressive locoregional therapy. Actuarial 5-year overall survival in this M1 cohort was 54%. Radiotherapy for clinical circumstances including extended regional (M1) disease, palliation of diffuse skin metastases, reirradiation and inoperable IBC will be discussed.

Management of inflammatory breast cancer: focus on radiotherapy with an evidence-based approach

Inflammatory breast cancer represents a rare and extremely aggressive subtype of breast cancer. Due to its rarity, prospective studies are a difficult goal to obtain in this field. Nowadays a multimodal approach seems to be the standard approach. Role and timing of surgery, radiotherapy and chemotherapy are still debated issues. In this scenario interest is rising in molecular and target therapies. We performed a review analyzing the management of this unfavorable disease focusing on the role of radiotherapy, with particular emphasis on levels of evidence.